Diffusion Tensor Imaging to Predict Long-term Outcome after Cardiac Arrest A Bicentric Pilot Study

作者：Luyt Charles Edouard^*; Galanaud Damien; Perlbarg Vincent; Vanhaudenhuyse Audrey; Stevens Robert D; Gupta Rajiv; Besancenot Hortense; Krainik Alexandre; Audibert Gerard; Combes Alain; Chastre Jean; Benali Habib; Laureys Steven; Puybasset Louis

来源：Anesthesiology, 2012, 117(6): 1311-1321.

DOI：10.1097/ALN.0b013e318275148c

Background: Prognostication in comatose survivors of cardiac arrest is a major clinical challenge. The authors%26apos; objective was to determine whether an assessment with diffusion tensor imaging, a brain magnetic resonance imaging sequence, increases the accuracy of 1 yr functional outcome prediction in cardiac arrest survivors. %26lt;br%26gt;Methods: Prospective, observational study in two intensive care units. Fifty-seven comatose survivors of cardiac arrest underwent brain magnetic resonance imaging. Fractional anisotropy (FA), a diffusion tensor imaging value, was measured in predefined white matter regions, and apparent diffusion coefficient was assessed in predefined grey matter regions. Prediction of unfavorable outcome at 1 yr was compared using four prognostic models: FA global, FA selected, apparent diffusion coefficient, and clinical classifiers. %26lt;br%26gt;Results: Of the 57 patients included in the study, 49 had an unfavorable outcome at 12 months. Areas under the receiver operating characteristic curve (95% CI) to predict unfavorable outcome for the FA global, FA selected, clinical, and apparent diffusion coefficient models were 0.92 (0.82-0.98), 0.96 (0.87-0.99), 0.78 (0.65-0.88), and 0.86 (0.74-0.94), respectively. The FA selected model had the best overall accuracy for predicting outcome, with a score above 0.44 having 94% (95% CI, 83-99%) sensitivity and 100% (95% CI, 63-100%) specificity for the prediction of unfavorable outcome. %26lt;br%26gt;Conclusion: Quantitative diffusion tensor imaging indicates that white matter damage is widespread after cardiac arrest. A prognostic model based on FA values in selected white matter tracts seems to predict accurately 1 yr functional outcome. These preliminary results need to be confirmed in a larger population.

• 出版日期2012-12